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S A N J OA Q U I N Environmental Health Department <br /> = C-)HNTY <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br /> the festival coordinator three <br /> AA (3)weeks prior to this event. <br /> 1. 1.Name of Event: V6�X Date(s): <br /> 2. The following is information about my organization/business: <br /> Name of organization/business: V5(yy�a T�)eng <br /> �� l-��� �� ��pp r �.� <br /> Address: � � ��`� l �• —V�_Lx cA 6(53E)a�� � <br /> Phone: 005 LQ Ile) �-{- Alternate: ( ) ( mow <br /> - �p,(n <br /> 3. List food to be sold or given to the public:ayfSU w_.10 rr/Y lW t 1 w1 � '�/' <br /> 4. 1 am providing food that is NOT prepared at home: [&es❑ No <br /> All food is prepared on-site or is from approved com((mercial facilities:As❑No <br /> Name of facility: Phone: ( 1 <br /> Address of facility: <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> Vbooth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> Greening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br /> asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br /> areas from the public. <br /> ❑ Other(specify): <br /> Note: The only operations not required to provide enclosed booths are those which sell beverages from <br /> approved dispensers, or prepackaged foods from approved sources. <br /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> P-4proved bottled water. <br /> ❑ On-site hose bib that is connected to a potable water source. <br /> ❑Other(specify): 14 <br /> 7. Electricity is provided for my booth's use: ❑ Ye No <br /> 8. 1 am providing an accurate probe thermomet r to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation ❑ No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> ,Camp stove ETSterno& hotel trays <br /> ❑Double steamer ❑ Steam table&lids <br /> ❑Electric stove top ❑ Other(specify) <br /> Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad, eggs, and dairy products. <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 7 of 11 TEMP EVENT APP <br /> 06/292023 <br /> Scanned with CamScanner <br />